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ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 4  |  Page : 269-274

The purpose of the text is the effectiveness/benefits of dragon fruit and guava fruit that can lower blood glucose levels in type 2 Diabetes Mellitus patients


1 Department of Dental Health, Poltekkes Kemenkes Palembang, Sumatera Selatan, Indonesia
2 Department of Nutrition, Poltekkes Kemenkes Palembang, Sumatera Selatan, Indonesia

Date of Submission23-May-2022
Date of Decision09-Jun-2022
Date of Acceptance08-Aug-2022
Date of Web Publication30-Nov-2022

Correspondence Address:
SST, MPH Muzakar
Department of Nutrition, Poltekkes Kemenkes Palembang, 30126 Palembang, Sumatera Selatan
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_31_22

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   Abstract 


Introduction: Diabetes mellitus (DM) is a serious chronic degenerative disease caused by insufficient insulin hormone, or the body’s ineffective use of the insulin produced, with clinical symptoms such as polyphagia, polydipsia, polyuria, weight loss, and weakness accompanied by blood sugar levels ≥ 200 mg/dL and fasting blood sugar ≥ 126 mg/dL. Material and Method: This was a quantitative study with a quasi-experimental design. Results: Most of the respondents were female (70%) either in the treatment group or (60%) in the comparison group and had an average age between 45 and 59 years (50%). The average decrease in blood sugar level was 69.40 mg/dL. Red guava (NAMBUIRA) showed an effect on the blood sugar levels in type 2 DM patients at Talang Ratu Palembang Public Health Center (P = 0.000). Conclusion: NAMBUIRA pudding contains antioxidants and is rich in fiber and had an effect on reducing blood sugar levels in patients with type 2 DM at Talang Ratu Public Health Center of Palembang.

Keywords: Blood glucose levels, diabetes mellitus, NAMBUIRA pudding


How to cite this article:
Listrianah, Muzakar, Susyani, Mulyaningsih N, Eliza, Sriwiyanti. The purpose of the text is the effectiveness/benefits of dragon fruit and guava fruit that can lower blood glucose levels in type 2 Diabetes Mellitus patients. Int J Nutr Pharmacol Neurol Dis 2022;12:269-74

How to cite this URL:
Listrianah, Muzakar, Susyani, Mulyaningsih N, Eliza, Sriwiyanti. The purpose of the text is the effectiveness/benefits of dragon fruit and guava fruit that can lower blood glucose levels in type 2 Diabetes Mellitus patients. Int J Nutr Pharmacol Neurol Dis [serial online] 2022 [cited 2023 Feb 6];12:269-74. Available from: https://www.ijnpnd.com/text.asp?2022/12/4/269/362412




   Introduction Top


Diabetes mellitus (DM) is a serious, chronic degenerative disease that occurs when the pancreas does not produce enough insulin (a hormone that regulates the level of sugar or glucose in the blood) or when the body cannot effectively utilize the insulin it produces. Diabetes is one of the deadliest diseases among the four non-communicable diseases in the world.[1]

According to Riset Kesehatan Dasar,[2] the prevalence of DM increased in 2013 (2.1%) when compared with that in 2007 when it was 1.1%.[2] Globally, an estimated 422 million adults were living with diabetes in 2014, and it is estimated to increase rapidly to 592 million people by 2035.[1] As per International Diabetes Federation (IDF), in 2013, 5.1 million people died due to diabetes (one person every 6 seconds), and the global prevalence of DM at age of ≥18 years was 8.5%. In 2015, an estimated 1.6 million deaths were directly caused by diabetes.[1]

South Sumatra Province was quite high in the number of DM patients, and Palembang City had the highest prevalence of DM (22.79%) compared to other districts/cities in South Sumatra Province, such as Banyuasin Regency (1.03%) and Ogan Komering Ilir Regency (1.42; results of data from the health profile of South Sumatra Province in 2010). In 2014, the Health Office of South Sumatra estimated 17,541 diabetes patients which increased to 22,042 in 2015.

Data recorded in 2018 at Talang Ratu Palembang Public Health Center estimated patients suffering from diabetes to be 159, while in 2017, there were 119 people recorded to be affected by diabetes.

Red dragon fruit (Hylocereus polyrhizus) is a type of cactus plant which is currently being discussed a lot. In Indonesia, dragon fruits are relatively new and are placed in a functional food category. From various media, this red dragon fruit has various beneficial properties in human health, one of which is in balancing blood glucose levels (blood sugar levels).[3]

Red dragon fruit is a rich source of fiber, calcium, magnesium, potassium, and sodium, as well as antioxidants which are useful in maintaining the elasticity of blood vessels.[4] Vitamin C, as an antioxidant, neutralizes the free radicals in the human body. Antioxidants are electron donating compounds that inhibit oxidation reactions by binding to free radicals and highly corrective molecules to prevent cell damage.[5]

Guava fruit is rich in fiber content, especially pectin (a water-soluble fiber) which has hypocholesterolemic and hypoglycemic effects and can lower cholesterol and glucose (blood sugar) levels. In general, the physiological role of dietary fiber is to increase fecal mass, slow down gastric emptying time, increase satiety after eating, reduce glucose absorption, and increase bile acid excretion.[6]

Several studies have also shown that fresh fruit and red guava juice can lower blood glucose levels by administering 1 g of red guava juice/kg body weight showing the effect of reducing blood glucose in normal and diabetic rats.[7]


   Materials and methods Top


Study design

This was a quantitative study with a quasi-experimental design. Experimental research is a form of research that seeks to isolate and control any conditions relevant to the situation and then observe the effect or effects when these conditions are affected. The study designs used were pretest and posttest, that is, take one measurement before (pretest) the treatment followed by another measurement (posttest) after the treatment.

The design of this study used pre and post tests with comparison and treatment groups, the scheme is as follows:



Key:

O1 = experimental group (blood sugar level check) before treatment,

O2 = experimental group (blood sugar level check) after treatment,

O3 = comparison group (blood sugar level check) before treatment,

O4 = comparison group (blood sugar level check) after treatment

X = treatment of giving red dragon fruit pudding and red guava seeds (NAMBUIRA pudding).

Sampling

This study included the outpatient DM patients in the work area of the Talang Ratu Health Center Palembang as the sample, who were determined using the accidental sampling technique. The sample size for this study was only 60 respondents divided into two groups with each group having 30 participants.

Statistical analysis

The collected data were entered into a Microsoft Excel sheet, cleaned, and exported to SPSS (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0) version 21. Data were analyzed using SPSS software. Descriptive statistics were conducted to determine the frequency, percentage, mean, and standard deviation. A paired t test was conducted to observe the mean difference for weight, hemoglobin, and Body Mass Index/Index Massa Tubuh (BMI/IMT) on preintervention and postintervention parameters at 95% confidence interval. A P-value < 0.05 was considered statistically significant.

Ethical information

This study was approved by Health Research Ethics Committee, Poltekkes Kemenkes Palembang No. 0292/KEPK/Adm2/III/2022.


   Results Top


Respondent characteristics

As shown in [Table 1], the participants were mostly female, aged between 45 and 59 years, and had a normal BMI.
Table 1 Respondent characteristics

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The average intake of nutrients, fiber, and vitamin C

As shown in [Table 2], as per the average intake from both the treatment and comparison groups, most of the carbohydrate intake was more than the requirement, the fat intake was less than the requirement, the protein intake was less than the requirement, the energy intake was less than the requirement, the fiber intake was lacking, and the vitamin C intake was enough as per their body’s need.
Table 2 The average intake of nutrients, fiber, and vitamin C

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The average blood glucose

Before the administration/intake of red dragon fruit pudding and red guava (NAMBUIRA) in the treatment group, the highest blood glucose level was 521 mg/dL and the lowest blood glucose level was 205 mg/dL with the average blood glucose level before treatment being 280.10 mg/dL [Table 3].
Table 3 The average blood glucose

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While in the comparison group, the highest blood glucose level before giving the red dragon fruit pudding and red guava (NAMBUIRA) was 406 mg/dL and the lowest blood glucose level was 213 mg/dL with the average blood glucose level before treatment being 262.63 mg/dL.

After giving the red dragon fruit pudding and red guava (NAMBUIRA) in the treatment group, the highest blood glucose level was 368 mg/dL and the lowest blood glucose level was 116 mg/dL with an average blood glucose level after treatment being 210.70 mg/dL.

While in the comparison group, the highest blood glucose level after giving the red dragon fruit pudding and red guava (NAMBUIRA) was 396 mg/dL and the lowest blood glucose level was 189 mg/dL with the average blood glucose level in the comparison group being 253.83 mg/dL.

The differences in blood glucose before and after treatment

In the t-dependent test, each group produced a p value < 0.05, from which it can be concluded that there was an effect on blood glucose levels before and after consuming red dragon fruit pudding and red guava (NAMBUIRA). Since the results of the treatment and comparison groups were both meaningful, an independent t test was conducted [Table 4].
Table 4 The differences in blood glucose before and after treatment

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The effect of NAMBUIRA pudding on decreasing blood glucose levels

As shown in [Table 5], based on the results of the statistical test (independent t test) with a P-value < 0.05, it can be concluded that there was an effect after consuming red dragon fruit pudding and red guava (NAMBUIRA) with a decrease in blood glucose levels in patients with DM.
Table 5 The effect of pudding NAMBUIRA on decreasing blood glucose levels

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   Discussion Top


As per [Table 1], it can be seen that of the 60 participants suffering from type 2 DM both in the treatment group and in the comparison group (30 each), the majority of them were women, 70% (21 people) in the treatment group and 60% (18 people) in the comparison group.

This was similar to the research conducted by Allorerung et al.,[8] which stated that the females were closely related to the incidence of DM. According to Tandra,[9] women were at higher risk of developing type 2 diabetes than men in relation to pregnancy, where the pregnancy was a risk factor for diabetes. In a study on gender and the incidence of type 2 DM, the prevalence of type 2 diabetes was higher in women than in men. Physically, women are more likely to have an obesity index, which increases their risk of developing type 2 diabetes.[9] However, this was inconsistent with the study done by Wicaksono,[10] who obtained a P-value of 0.795. This means that there was no association between gender and the incidence of type 2 diabetes.[10]

This was in line with the research done by Betteng.[11] According to this study, in general, people experience physiologic changes that decrease rapidly and dramatically after the age of 40. Diabetes often occurs when a person enters a vulnerable age, especially after the age of 45, resulting in the body becoming less sensitive to insulin.[11]

As per [Table 2], the average intake of carbohydrates, fats, proteins, and energy in each group was still low. The main function of carbohydrates is to provide energy to cells, including brain cells. The function of brain cells depends on the supply of carbohydrates in the form of glucose. Lack of blood sugar can lead to hypoglycemia, but excess glucose in the blood can cause a condition called hyperglycemia, and if it persists, it can increase the risk of developing diabetes.[12]

According to Kamandanu,[13] high fat intake does not affect blood sugar levels but can cause coronary artery blockages, with one of the main risk factors being dyslipidemia.

According to Kartasa and Marsetyo,[14] protein intake that is not in accordance with the needs of the body will affect blood sugar levels because one of the functions of protein is as a source of energy in the body. To be converted into energy, several types of amino acids enter the carbohydrate pathway through the process called gluconeogenesis. This can also occur when the body lacks energy through food intake.

Hypoglycemia will occur, if people with type 2 Diabetes Mellitus have more or less energy intake,[15] which was in line with the study by Kedia,[16] who stated that hypoglycemia can cause permanent brain damage, as well as coma leading to death. Also, prolonged hypoglycemia can cause moderate to severe neuropsychological disorders.[17]

Foods that are highly recommended for diabetics are high-fiber foods, especially foods that contain soluble fiber. This type of fiber can slow down the absorption of glucose after meals and also affects the absorption of fat from the digestive tract.[18] The process by which fiber absorbs glucose and fat by increasing the thickness of the stool. This indirectly slows down the rate of diffusion, lowering blood sugar levels, lipid profiles, and cholesterol.[19] The mechanism of food fiber which reduces blood sugar levels in diabetes patients is by reducing the efficiency of absorption of carbohydrates, causing a decrease in insulin response and resulting in lighter work of the pancreas so that it can improve the function of the pancreas in producing insulin.[7]

Based on research conducted by Wulandari et al.,[20] Vitamin C can increase insulin sensitivity and lower blood sugar levels, leading to the reduction in glucose toxicity and prevention of lower beta cell mass and insulin levels. Vitamin C plays a role in regulating the action of insulin in diabetics, especially in nonoxidative glucose metabolism with its role in lowering blood glucose levels.[20]

As shown in [Table 4], the statistical test results (dependent t test) were obtained in the treatment group with a P-value of 0.000 while in the comparison group the P-value was 0.033. As the P-values of both groups were <0.05, it can be concluded that there was an effect of decreasing blood glucose levels. The NAMBUIRA pudding was given to the treatment group but not the comparison group, though they still consumed Oral Hypoglycemic Drugs (OHO).

The blood glucose-lowering effect of this treatment group was consistent with a study conducted by Hidayati[19] which evaluated the effect of administration of 200 g of red dragon fruit on fasting blood glucose (BIP) levels in patients with type 2 diabetes mellitus of 19.1 mg/dL.[19] According to a study done by Wiardana et al.,[4] administration of 200 g of red dragon fruit juice helped reduce blood glucose levels by 79.1 mg/dL 2 Jam Post Prondrial (2 hours after Prondrial).

In addition, Jasmani[21] found that fasting blood glucose levels decreased in three treatment groups who were given red guava juice at different doses (3.6 g/head/day, 7.2 g/head/day, and 10.8 g/head) due to the antioxidant activity of red guava.

NAMBUIRA pudding can be used as a healthy snack in people with DM because red dragon fruit pudding and red guava contain ingredients such as anthocyanins, flavonoids, antioxidants, vitamin C, and fiber which can regulate and reduce blood sugar levels in the body.

This decrease in blood glucose levels was possible as red dragon fruit contains the components that can provide a hypoglycemic effect which serves to balance blood glucose levels, such as fiber and antioxidants (flavonoids).[22] Based on a study by Ruhe and McDonald,[23] antioxidants can remove free radicals, reduce insulin resistance, and reduce reactive oxygen species (ROS).

In addition to flavonoids, red dragon fruit is rich in dietary fiber (0.7–0.9 g/100 g of fruit). Dietary fiber is a water-soluble fiber that can be used in hypoglycemic therapy. The role of dietary fiber in a hypoglycemic therapy is to improve insulin sensitivity and reduce insulin requirements by increasing intestinal food transit time, delaying gastric emptying, and slowing down glucose absorption.[24]

Not only flavonoids and fiber, red dragon fruit contain a vitamin C content that can affect fasting blood glucose (GDP) levels as well as fruit fiber. Red dragon fruit contains 540.27 mg of vitamin C/100 g of fruit, which is six times the required amount. The highly rich vitamin C content in red dragon fruit acts as an antioxidant, increases endothelial function, reduces oxidative stress, and reduces insulin resistance.[25]

The flavonoid in the form of quercetin is one of the compounds found in vegetables and fruits that functions to provide an antioxidant effect. The antioxidant action of flavonoids can prevent free radicals from releasing deep pancreatic beta cells that secrete insulin. Quercetin compounds can inhibit the lipid peroxidation system which depends on Fe ions and then chelates the Fe ions. The thickening of the Fe ion causes an inert ion complex and cannot initiate the lipid formation, resulting in regeneration and repair of pancreatic beta cells which in turn can stimulate beta cells to secrete insulin.[5] Red guava is one of the rich sources of natural vitamin C which has high levels of vitamin C compared to other fruits such as oranges or papaya at a dose of 183 mg/100 g of red guava fruit.[26]

The fiber content of red guava fruit is also very high, 5.4 g/100 g guava fruit. The type of fiber that is quite high in guava is pectin. Pectin is a type of water-soluble dietary fiber. It is a compound that can coat carbohydrate molecules to inhibit their absorption and release carbohydrate molecules slowly. This absorption barrier reduces the amount of sugar that enters the blood after a meal, thus avoiding elevated blood sugar levels. In addition, pectin increases stool bulk, slows gastric emptying time, increases postprandial satiety, and increases bile acid excretion.[27]

Used not only in the flesh of the guava fruit but the skin of the guava fruit is also rich in water-soluble fiber, it can interfere with the absorption of blood sugar and fat from food and excrete it outside the body.[28]


   Conclusion Top


This study showed prominent results in a reduction of the average blood glucose levels as the average blood glucose level before treatment was 280.10 mg/dL and 210.70 mg/dL after the treatment. Administration of red dragon fruit pudding and red guava (NAMBUIRA) showed a reduction in blood glucose levels after the treatment. This is because red dragon fruit and red guava pudding contain ingredients that can help regulate and lower blood sugar levels.

Acknowledgments

The authors would like to thank the Talang Ratu Palembang Health Center for permitting for this research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Kartasapoetra G, Marsetyo H. Ilmu gizi: korelasi gizi, kesehatan, dan produktivitas kerja. 5th ed. Jakarta: Penerbit Rineka Cipta; 2005.  Back to cited text no. 14
    
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Kedia N. Treatment of severe diabetic hypoglycemia with glucagon: an underutilized therapeutic approach. Diabetes Metab Syndr Obes 2011;4:337-46. doi: 10.2147/DMSO. S20633.  Back to cited text no. 16
    
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Wijaya IN, Faturrohmah A, Yuda A et al. Profil penggunaan obat pada pasien diabetes melitus di puskesmas wilayah surabaya timur. J Farm Komun 2010;2;23-8.  Back to cited text no. 28
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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